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Zhang Y, Chen M, Liu C, He B, Dang H, Li J, Chen H, Liang Z. Global trends and research hotspots of stroke and magnetic resonance imaging: A bibliometric analysis. Medicine (Baltimore) 2023; 102:e36545. [PMID: 38134079 PMCID: PMC10735157 DOI: 10.1097/md.0000000000036545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 11/17/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND In this study, we used CiteSpace and VOSviewer to create a bibliometric visualization of research papers relating to stroke and magnetic resonance imaging (MRI) between 2000 and 2022. To fully understand the trends and hotspots in MRI and stroke research and provide new perspectives for future studies. METHODS The Web of Science Core Collection was selected as the source of data for this paper. Using CiteSpace and VOSviewer, publications were analyzed for authors, countries, institutions, journals, references, and keywords. RESULTS We found 1423 papers after searching and removing duplicates, which indicated an upward trend over the previous 23 years. Fiebach J.B. is the most published author (21 publications), Hacke W. is the most cited author (213 citations), and the United States (449 publications) and Harvard University (86 publications) are the most prolific nations and institutions. Stroke is the journal with the most co-citations (1275) and the most papers (171) published. The most representative reference was the 1995 article by Marler et al, which received 115 citations and had the top 3 co-occurring keywords: stroke, magnetic resonance imaging, and MRI. The article by Nogueria et al showed the strongest citation burst at the end of 2022 (strength = 17.32). High-frequency keywords in recent years are time, association, functional connectivity, thrombectomy, and rehabilitation. CONCLUSION This study provides a scientific perspective on stroke and MRI research, provides valuable information for researchers to understand the current status of research, hotspots, and trends, and guides future research directions.
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Affiliation(s)
- Yuting Zhang
- Department of Radiology, Panyu Health Management Center (Panyu Rehabilitation Hospital), Guangzhou, China
- College of Acupuncture Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Mengtong Chen
- Department of Radiology, Panyu Health Management Center (Panyu Rehabilitation Hospital), Guangzhou, China
- College of Acupuncture Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Chunlong Liu
- College of Acupuncture Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Bingjie He
- Department of Radiology, Panyu Health Management Center (Panyu Rehabilitation Hospital), Guangzhou, China
| | - Hongbin Dang
- Department of Radiology, Panyu Health Management Center (Panyu Rehabilitation Hospital), Guangzhou, China
| | - Jiamin Li
- Department of Radiology, Panyu Health Management Center (Panyu Rehabilitation Hospital), Guangzhou, China
| | - Hanwei Chen
- Department of Radiology, Panyu Health Management Center (Panyu Rehabilitation Hospital), Guangzhou, China
| | - Zhenzhong Liang
- Department of Radiology, Panyu Health Management Center (Panyu Rehabilitation Hospital), Guangzhou, China
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Abstract
Multimodal MR imaging provides valuable information in the management of patients with acute ischemic stroke (AIS), with diagnostic, therapeutic, and prognostic implications. MR imaging plays a critical role in treatment decision making for (1) thrombolytic treatment of AIS patients with unknown symptom-onset and (2) endovascular treatment of patients with large vessel occlusion presenting beyond 6 hours from the symptom onset. MR imaging provides the most accurate information for detection of ischemic brain and is invaluable for differentiating AIS from stroke mimics.
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Li J, Zhang S, Liu X, Han D, Xu J, Ma Y. Neuroprotective effects of leonurine against oxygen-glucose deprivation by targeting Cx36/CaMKII in PC12 cells. PLoS One 2018; 13:e0200705. [PMID: 30016355 PMCID: PMC6049927 DOI: 10.1371/journal.pone.0200705] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 07/02/2018] [Indexed: 01/31/2023] Open
Abstract
Leonurine has been reported to play an important role in ameliorating cognitive dysfunction, inhibiting ischemic stroke, and attenuating perihematomal edema and neuroinflammation in intracerebral hemorrhage. However, the exact mechanism and potential molecular targets of this effect remain unclear. Thus, in this study we investigated the neuroprotective effects of leonurine on hypoxia ischemia injury and explored the underlying mechanisms. An in vitro model of oxygen-glucose deprivation (OGD)-induced PC12 cells was established to mimic ischemic-like conditions. Cell viability, apoptosis, Cx36 and pCaMKII/CaMKII expression levels were evaluated after treatment with leonurine. The Cx36-selective antagonist mefloquine and CaMKII Inhibitor KN-93 were used to investigate the neuroprotective effect of leonurine on and the involvement of Cx36/CaMKII in this process. The results revealed that cell viability decreased and cell apoptosis and the protein expression of Cx36 and pCaMKII/CaMKII increased in the OGD-induced PC12 cells. Leonurine significantly increased cell viability and decreased cell apoptosis and the protein expression of Cx36 and pCaMKII/CaMKII in the OGD-induced PC12 cells. The specific inhibitor of Cx36 and CaMKII displayed similar protective effects. Moreover, the inhibition of Cx36 reduced pCaMKII levels and the ratio of pCaMKII/CaMKII in the OGD-induced PC12 cells, and vice versa. Taken together, these results suggest that leonurine might have a protective effect on OGD-induced PC12 cells through targeting the Cx36/CaMKII pathway. Thus, leonurine appears to have potential as a preventive or therapeutic drug against ischemic-induced neuronal injury.
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Affiliation(s)
- Jiao Li
- College of Veterinary Medicine, China Agricultural University, Beijing, China
| | - Shuang Zhang
- College of Veterinary Medicine, China Agricultural University, Beijing, China
| | - Xiaoxi Liu
- College of Veterinary Medicine, China Agricultural University, Beijing, China
| | - Deping Han
- College of Veterinary Medicine, China Agricultural University, Beijing, China
| | - Jianqin Xu
- College of Veterinary Medicine, China Agricultural University, Beijing, China
| | - Yunfei Ma
- College of Veterinary Medicine, China Agricultural University, Beijing, China
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Rudkin S, Cerejo R, Tayal A, Goldberg MF. Imaging of acute ischemic stroke. Emerg Radiol 2018; 25:659-672. [DOI: 10.1007/s10140-018-1623-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 06/26/2018] [Indexed: 10/28/2022]
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5
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Vilela P, Rowley HA. Brain ischemia: CT and MRI techniques in acute ischemic stroke. Eur J Radiol 2017; 96:162-172. [DOI: 10.1016/j.ejrad.2017.08.014] [Citation(s) in RCA: 104] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 08/07/2017] [Accepted: 08/12/2017] [Indexed: 11/17/2022]
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Malhotra K, Liebeskind DS. Imaging in Endovascular Stroke Trials. J Neuroimaging 2016; 25:517-27. [PMID: 26179500 DOI: 10.1111/jon.12272] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 05/21/2015] [Indexed: 01/19/2023] Open
Abstract
Ischemic stroke remains a leading cause of death and disability worldwide. Various endovascular trials have addressed clinical outcomes without elucidating the impact of imaging studies in patient selection. The success of recent endovascular trials was bolstered by the use of advanced imaging techniques for optimal selection of reperfusion candidates. This seminal juncture in the history of stroke trials warrants further consideration on the use of imaging to guide future refinements in the treatment of acute stroke. In this article, we systematically review the imaging methodology and key facets used in all published endovascular stroke trials to date, discuss the success of recent trials using latest advanced imaging techniques and focus on the importance of imaging studies for future patient selection.
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Affiliation(s)
| | - David S Liebeskind
- Neurovascular Imaging Research Core and the UCLA Stroke Center, Los Angeles, CA
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Wintermark M, Sanelli PC, Albers GW, Bello J, Derdeyn C, Hetts SW, Johnson MH, Kidwell C, Lev MH, Liebeskind DS, Rowley H, Schaefer PW, Sunshine JL, Zaharchuk G, Meltzer CC. Imaging recommendations for acute stroke and transient ischemic attack patients: A joint statement by the American Society of Neuroradiology, the American College of Radiology, and the Society of NeuroInterventional Surgery. AJNR Am J Neuroradiol 2013; 34:E117-27. [PMID: 23907247 DOI: 10.3174/ajnr.a3690] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
SUMMARY Stroke is a leading cause of death and disability worldwide. Imaging plays a critical role in evaluating patients suspected of acute stroke and transient ischemic attack, especially before initiating treatment. Over the past few decades, major advances have occurred in stroke imaging and treatment, including Food and Drug Administration approval of recanalization therapies for the treatment of acute ischemic stroke. A wide variety of imaging techniques has become available to assess vascular lesions and brain tissue status in acute stroke patients. However, the practical challenge for physicians is to understand the multiple facets of these imaging techniques, including which imaging techniques to implement and how to optimally use them, given available resources at their local institution. Important considerations include constraints of time, cost, access to imaging modalities, preferences of treating physicians, availability of expertise, and availability of endovascular therapy. The choice of which imaging techniques to employ is impacted by both the time urgency for evaluation of patients and the complexity of the literature on acute stroke imaging. Ideally, imaging algorithms should incorporate techniques that provide optimal benefit for improved patient outcomes without delaying treatment.
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Affiliation(s)
- M Wintermark
- Departments of Radiology, Neurology, Neurosurgery, and Biomedical Engineering, University of Virginia, Charlottesville, Virginia
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9
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Zhao Z, Bai Q, Sui H, Xie X, Wen F. Fast multimode MRI based emergency assessment of hyperacute stroke thrombolysis. Neurol Res 2013; 31:346-50. [DOI: 10.1179/174313209x444053] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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10
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Jain AR, Jain M, Kanthala AR, Damania D, Stead LG, Wang HZ, Jahromi BS. Association of CT perfusion parameters with hemorrhagic transformation in acute ischemic stroke. AJNR Am J Neuroradiol 2013; 34:1895-900. [PMID: 23598828 DOI: 10.3174/ajnr.a3502] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Prediction of hemorrhagic transformation in acute ischemic stroke could help determine treatment and prognostication. With increasing numbers of patients with acute ischemic stroke undergoing multimodal CT imaging, we examined whether CT perfusion could predict hemorrhagic transformation in acute ischemic stroke. MATERIALS AND METHODS Patients with acute ischemic stroke who underwent CTP scanning within 12 hours of symptom onset were examined. Patients with and without hemorrhagic transformation were defined as cases and controls, respectively, and were matched as to IV rtPA administration and presentation NIHSS score (± 2). Relative mean transit time, relative CBF, and relative CBV values were calculated from CTP maps and normalized to the contralateral side. Receiver operating characteristic analysis curves were created, and threshold values for significant CTP parameters were obtained to predict hemorrhagic transformation. RESULTS Of 83 patients with acute ischemic stroke, 16 developed hemorrhagic transformation (19.28%). By matching, 38 controls were found for only 14 patients with hemorrhagic transformation. Among the matched patients with hemorrhagic transformation, 13 developed hemorrhagic infarction (6 hemorrhagic infarction 1 and 7 hemorrhagic infarction 2) and 1 developed parenchymal hematoma 2. There was no significant difference between cases and controls with respect to age, sex, time to presentation from symptom onset, and comorbidities. Cases had significantly lower median rCBV (8% lower) compared with controls (11% higher) (P = .009; odds ratio, 1.14 for a 0.1-U decrease in rCBV). There was no difference in median total volume of ischemia, rMTT, and rCBF among cases and controls. The area under the receiver operating characteristic was computed to be 0.83 (standard error, 0.08), with a cutoff point for rCBV of 1.09. CONCLUSIONS Of the examined CTP parameters, only lower rCBV was found to be significantly associated with a relatively higher chance of hemorrhagic transformation.
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Ferrazzano P, Shi Y, Manhas N, Wang Y, Hutchinson B, Chen X, Chanana V, Gerdts J, Meyerand ME, Sun D. Inhibiting the Na+/H+ exchanger reduces reperfusion injury: a small animal MRI study. Front Biosci (Elite Ed) 2011; 3:81-8. [PMID: 21196287 DOI: 10.2741/e222] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We used magnetic resonance imaging (MRI) to assess the efficacy of Na+/H+ exchanger isoform 1 (NHE-1) inhibition following cerebral ischemia. Transient focal cerebral ischemia was induced in wild-type controls (NHE-1(+/+)), NHE-1 genetic knockdown mice (NHE-1(+/-)), and NHE-1(+/+) mice treated with the selective NHE-1 inhibitor HOE642. Diffusion weighted imaging (DWI) revealed a brain lesion as early as 1 hour following reperfusion and illustrated significant protection in NHE-1(+/-) mice (16.2 +/- 7.9 mm3 in NHE-1(+/-) mice vs. 47.5 +/- 16.6 mm3 in NHE-1(+/+) mice). Knockdown of NHE-1 showed significantly smaller infarct at 72 hours on T2 imaging (21.2 +/- 12.6 mm3 in NHE-1(+/-) mice vs. 64.6 +/- 2.5 mm3 in NHE-1(+/+) mice). Administration of HOE642 prior to reperfusion or during early reperfusion reduced ischemic damage. Thus, high resolution T2 images can be used for consistent and precise calculation of lesion volumes, while changes of DWI are a sensitive early marker of ischemic injury. The results of this study demonstrate the therapeutic potential for inhibition of NHE-1 in treating cerebral ischemia.
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Affiliation(s)
- Peter Ferrazzano
- Department of Pediatrics, University of Wisconsin, Madison, WI 53792, USA.
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Latchaw RE, Alberts MJ, Lev MH, Connors JJ, Harbaugh RE, Higashida RT, Hobson R, Kidwell CS, Koroshetz WJ, Mathews V, Villablanca P, Warach S, Walters B. Recommendations for imaging of acute ischemic stroke: a scientific statement from the American Heart Association. Stroke 2009; 40:3646-78. [PMID: 19797189 DOI: 10.1161/strokeaha.108.192616] [Citation(s) in RCA: 291] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Abstract
Diffusion and perfusion MR imaging have proven to be highly useful in the clinical description and understanding of acute and hyperacute ischemic stroke. In this article, the authors give a brief overview of the basic concepts of diffusion and perfusion imaging and describe some of the current developments, applications, challenges, and limitations of these techniques as applied to cerebral ischemia.
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Harris AD, Kosior RK, Chen HS, Andersen LB, Frayne R. Evolution of hyperacute stroke over 6 hours using serial MR perfusion and diffusion maps. J Magn Reson Imaging 2009; 29:1262-70. [PMID: 19472379 DOI: 10.1002/jmri.21763] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To develop an appropriate method to evaluate the time-course of diffusion and perfusion changes in a clinically relevant animal model of ischemic stroke and to examine lesion progression on MR images. An exploration of acute stroke infarct expansion was performed in this study by using a new methodology for developing time-to-infarct maps based on the time at which each voxel becomes infarcted. This enabled definition of homogeneous regions from the heterogeneous stroke infarct. MATERIALS AND METHODS Time-to-infarct maps were developed based on apparent diffusion coefficient (ADC) changes. These maps were validated and then applied to blood flow and time-to-peak maps to examine perfusion changes. RESULTS ADC stroke infarct showed different evolution patterns depending on the time at which that region of tissue infarcted. Applying the time-to-infarct maps to the perfusion maps showed localized perfusion evolution characteristics. In some regions, perfusion was immediately affected and showed little change over the experiment; however, in some regions perfusion changes were more dynamic. CONCLUSION Results were consistent with the diffusion-perfusion mismatch hypothesis. In addition, characteristics of collateral recruitment were identified, which has interesting stroke pathophysiology and treatment implications.
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Affiliation(s)
- Ashley D Harris
- Seaman Family MR Research Centre, Foothills Medical Centre, University of Calgary, Alberta, Canada
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15
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Thulborn KR. MRI in the management of cerebrovascular disease to prevent stroke. Neurol Clin 2009; 26:897-921, vii-viii. [PMID: 19026896 DOI: 10.1016/j.ncl.2008.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Cerebrovascular disease is a heterogeneous disease that may require objective criteria for developing optimal recurrent stroke prevention strategies. MRI and magnetic resonance angiography together with magnetic resonance perfusion and functional MRI provide sufficient parameters to tailor medical and surgical interventions for each patient and to monitor disease compensation or progression. These MRI procedures are demonstrated by clinical cases of advanced cerebrovascular pathology in which treatment varied from medical management to surgical intervention.
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Affiliation(s)
- Keith R Thulborn
- Center for Magnetic Resonance Research, University of Illinois Medical Center at Chicago, 1801 West Taylor Street, Suite 1307, Chicago, IL 60612, USA.
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Kelly ME, Turner RD, Moskowitz SI, Gonugunta VR, Rasmussen PA, Masaryk TJ, Fiorella D. Revascularization of symptomatic subacute cerebrovascular occlusions with a self-expanding intracranial stent system. Neurosurgery 2009; 64:72-8; discussion 78. [PMID: 19050658 DOI: 10.1227/01.neu.0000334049.12472.b7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE In some patients, collateral circulation may preserve the viability of brain parenchyma distal to an intracranial arterial occlusion for hours or days after the presenting event. These patients may be good candidates for revascularization, even when they present outside of the accepted 6-hour time window for stroke intervention. METHODS Three patients were revascularized with the Wingspan stent system (Boston Scientific/Target, Fremont, CA) after presenting with subacute occlusions of intracranial arteries and progressive ischemic symptoms despite maximal medical therapy. All pre- and postprocedural imaging data and clinical records were reviewed. RESULTS Three patients (mean age, 64 years; 2 women, 1 man) presented with symptomatic intracranial occlusions of the internal carotid artery (n = 2) and vertebrobasilar system (n = 1). All 3 patients presented more than 6 hours after symptom onset, and no intravenous or intra-arterial thrombolysis had been instituted. In all cases, despite supportive medical therapy (anticoagulation and antiplatelet therapy and induced hypertension), the patients continued to demonstrate progressive ischemia, both clinically and on diffusion magnetic resonance imaging. All patients were successfully revascularized without periprocedural complications and improved clinically after revascularization. CONCLUSION In selected patients, symptomatic subacute occlusions of intracranial arteries may be revascularized using the Wingspan stent system.
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Affiliation(s)
- Michael E Kelly
- Division of Neurosurgery, Royal University Hospital, Saskatoon, Canada
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Cloft HJ, Rabinstein A, Lanzino G, Kallmes DF. Intra-arterial stroke therapy: an assessment of demand and available work force. AJNR Am J Neuroradiol 2009; 30:453-8. [PMID: 19131412 PMCID: PMC7051462 DOI: 10.3174/ajnr.a1462] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Intra-arterial therapy is currently applicable to a small subset of patients with ischemic stroke, but it will likely have an expanding role as new devices are introduced. This review evaluates the demand for such therapy and the physician work force available to provide such therapy in the United States. The available literature was reviewed to assess how many patients might need intra-arterial therapy annually and how many skilled neurointerventionalists are available to provide intra-arterial therapy for acute stroke. The number of acute ischemic strokes in the United States that will be amenable to intra-arterial therapy can only be crudely estimated, but it is certainly less than 126,000 per year and will quite likely be no more than 20,000 cases per year. The future demand for intra-arterial reperfusion techniques may change, but the number of patients who require intra-arterial thrombolysis is currently quite low. The overall number of neurointerventionists is currently adequate, though there might be local shortages.
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Affiliation(s)
- H J Cloft
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA.
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Josephs SC, Rowley HA, Rubin GD. Atherosclerotic Peripheral Vascular Disease Symposium II: vascular magnetic resonance and computed tomographic imaging. Circulation 2009; 118:2837-44. [PMID: 19106405 DOI: 10.1161/circulationaha.108.191173] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Bristow MS, Poulin BW, Simon JE, Hill MD, Kosior JC, Coutts SB, Frayne R, Mitchell JR, Demchuk AM. Identifying lesion growth with MR imaging in acute ischemic stroke. J Magn Reson Imaging 2008; 28:837-46. [DOI: 10.1002/jmri.21507] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Bai Q, Zhao Z, Li Y, Sui H, Xie X, Gong Y, Zhao X, Wang L, Xia W, Shen J, Lu L. The application of fast multiparametric protocol MRI-based thrombolysis with rt-PA hyperacute cerebral infarction. Neurol Res 2008; 30:344-7. [PMID: 18544249 DOI: 10.1179/174313208x300314] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE To investigate the value of fast multiparametric protocol magnetic resonance imaging (MRI)-based thrombolysis in hyperacute cerebral infarction. METHODS Seventy-seven patients with acute ischemic stroke were examined by multiparametric protocol MRI and among them, 12 patients with hyperacute cerebral infarction were treated by recombinant tissue plasminogen activator (rt-PA) and followed up periodically by MRI. RESULTS The 12 patients selected by FMPMRI to receive thrombolysis demonstrated clinical improvement, with 90 day modified Rankin scale scores (mRs) < or = 2 and life quality Barthel index (BI) of 80-100. The only complication involved one patient (8.3%) who developed an asymptomatic intracranial hemorrhage 3 weeks after receiving thrombolytics. CONCLUSION Multiparametric protocols have significant clinical potential for the treatment of hyperacute stroke patients who are candidates for receiving intravenous thrombolytic therapy. Our data suggest that patients suffering from hyperacute ischemic cerebral infarction that are strong candidates for intravenous thrombolytic therapy can be identified by multiparametric protocol MRI, especially to those whose time windows were undefined or beyond 3 hours after symptom onset.
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Affiliation(s)
- Qingke Bai
- Department of Neurology, People's Hospital of Pudong New Area, Shanghai, China
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Lin K, Kazmi KS, Law M, Babb J, Peccerelli N, Pramanik BK. Measuring elevated microvascular permeability and predicting hemorrhagic transformation in acute ischemic stroke using first-pass dynamic perfusion CT imaging. AJNR Am J Neuroradiol 2007; 28:1292-8. [PMID: 17698530 PMCID: PMC7977671 DOI: 10.3174/ajnr.a0539] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Hemorrhagic transformation (HT) can be a devastating complication of acute ischemic stroke (AIS). The purpose of this study was to determine whether increased microvascular permeability (PS) of the blood-brain barrier was detected in early AIS by using first-pass dynamic perfusion CT (PCT) and whether PS was significantly higher in infarcts destined for HT. MATERIALS AND METHODS Fifty patients with AIS less than 3 hours old and evaluated by PCT were included. PS color maps were retrospectively generated from PCT data using the Patlak model. One reader analyzed each PS map by drawing 4 circular 10-mm regions of interest on any focal abnormality. The mean of these 4 regions of interest represented the PS of the infarct (PSinfarct). The mean of 4 mirror regions of interest on the nonischemic contralateral hemisphere was also obtained (PScontrol). PSinfarct and PScontrol were compared by using an exact Wilcoxon test. PSinfarct for infarcts that developed HT on follow-up (PSHT) was compared with all of the others (PSNo-HT) using an exact Mann-Whitney test. RESULTS Forty-four infarcts (88%) showed focal PS elevation in the region of infarct. In units of milliliters per 100 milliliters per minute, PSinfarct ranged from 0 to 13 (mean: 3.5+/-3.1) versus PScontrol of 0-0.8 (mean: 0.28+/-0.27; P<.0001). Six infarcts (12%) developed HT, all of which were within the region of PS elevation. PSHT ranged from 5.2 to 13 (mean: 9.8+/-2.9) versus PSNo-HT of 0-5.9 (mean: 2.7+/-2.0; P<.0001). Eighteen infarcts (36%) were treated with recombinant tissue plasminogen activator (rtPA). A significant difference between PSHT and PSNo-HT persisted irrespective of rtPA treatment. CONCLUSIONS Elevated permeability was detectable in AIS by using first-pass PCT and it predicted subsequent HT.
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Affiliation(s)
- K Lin
- Department of Radiology, New York University Medical Center, New York, NY 10029, USA
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Fiehler J, Albers GW, Boulanger JM, Derex L, Gass A, Hjort N, Kim JS, Liebeskind DS, Neumann-Haefelin T, Pedraza S, Rother J, Rothwell P, Rovira A, Schellinger PD, Trenkler J. Bleeding risk analysis in stroke imaging before thromboLysis (BRASIL): pooled analysis of T2*-weighted magnetic resonance imaging data from 570 patients. Stroke 2007; 38:2738-44. [PMID: 17717319 DOI: 10.1161/strokeaha.106.480848] [Citation(s) in RCA: 199] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE There has been speculation that the risk of secondary symptomatic intracranial hemorrhage (SICH) may be increased after thrombolytic therapy in ischemic stroke patients who have cerebral microbleeds (CMBs) on T2*-weighted magnetic resonance imaging. Because of this concern, some centers withhold potentially beneficial thrombolytic therapy from these patients. METHODS We analyzed magnetic resonance imaging data acquired within 6 hours after symptom onset from 570 ischemic stroke patients treated with intravenous tissue plasminogen activator in 13 centers in Europe, North America, and Asia. Baseline T2*-weighted magnetic resonance images were evaluated for the presence of CMBs. The primary end point was SICH, defined as clinical deterioration with an increase in the National Institutes of Health Stroke Scale score by >or=4 points, temporally related to a parenchymal hematoma on follow-up-imaging. RESULTS A total of 242 CMBs were detected in 86 of 570 patients (15.1%). The number of CMBs ranged from 1 to 77 in the individual patient, with >or=5 CMBs in 6 of 570 patients (1.1%). Proportions of patients with SICH were 5.8% (95% CI, 1.9 to 13.0) in the presence of CMBs and 2.7% (95% CI, 1.4 to 4.5) in patients without CMBs (P=0.170, Fisher's exact test), resulting in no significant absolute increase in the risk of SICH of 3.1% (95% CI, -2.0 to 8.3). CONCLUSIONS The data suggest that if there is any increased risk of SICH attributable to CMBs, it is likely to be small and unlikely to exceed the benefits of thrombolytic therapy. No reliable conclusion regarding risk in the rare patient with multiple CMBs can be reached.
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Affiliation(s)
- Jens Fiehler
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
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